elections, nursing care, unions



  1. Palthe, Jennifer PhD, MLIR, BSSc
  2. Deshpande, Satish P. PhD


This empirical study examines 387 union certification elections conducted by the National Labor Relations Board in nursing care facilities (North American Industry Classification System 623) from January 1999 to December 2001. Unions won 60% of the elections. Service Employees International Union was involved in 42% of the elections. Bargaining unit size significantly impacted union victory. Unions had a better probability of winning elections in the northeast and midwest than in the south. Unlike other industries, American Federation of Labor-Congress of Industrial Organizations affiliated unions did not suffer a big labor image in nursing care facilities. Implications for union organizers and administrators of nursing care facilities are discussed.


THE HEALTH SERVICES sector employs nearly 11 million people in the United States.1 It is one of the largest and fastest growing sectors of the U.S. economy. According to the U.S. Department of Labor, nearly 13% of all wage and salary jobs created between 2000 and 2010 will be in this sector. In addition, 9 of 20 fastest growing occupations also are in this sector.1,2


One of the most serious challenges facing healthcare management in the United States is an acute shortage of nurses. According to the Joint Commission on the Accreditation of Healthcare Organizations, there are ~126,000 nursing vacancies in the United States.3 This has resulted in nurses being forced to work overtime and handle more patients. According to the Joint Commission on the Accreditation of Healthcare Organizations, an average nurse works nearly 8.5 weeks extra each year.3 This can have a serious impact on the quality of patient care. A recent study suggests a direct link between a nurse's workload and patient death in postoperative wards.4,5 Some states like Minnesota and New Jersey are responding to this problem by passing laws to restrict mandatory overtime.6 Similar legislation is being considered in a number of other states. This is consistent with a recent survey of 7000 registered nurses by the American Nurses Association in which nearly 75% of the nurses reported that the quality of nursing where they work has declined over the last 2 years.7 In addition, >40% of the nurses said that they would not feel comfortable having someone close to them being cared for where they work.7


One of the major segments of the health services industry is nursing and personal care facilities. These facilities employ nearly 18% of the workers in the health services industry and typically provide inpatient nursing and rehabilitation.1 In addition, they provide personal care to those who do not need hospital care but require continuous healthcare. Given that the elderly population in the United States is expected to grow at a faster rate than the general population between 2000 and 2010, it is not surprising that the U.S. Department of Labor expects employment in nursing and personal care facilities to go up by nearly 22% during the same period.1,2


Nurses and psychiatric and home health aides occupy >60% of the jobs in this field.1 On average, a worker in a nursing and personal care facility earns much less than an average worker in the health service industry overall ($349 vs.$474 per week).1 In addition, the nursing home industry ranks among the highest in injuries and illness. The average number of nonfatal occupational injuries and illnesses in nursing homes is considerably more than the average occurring in the private sector.1,8 Recently, the Occupational Safety and Health Administration announced that they would specifically target the nursing home and personal care facilities sector for inspection for specific hazards.8 Low wages and poor working conditions, coupled with increased union interest, has made this sector ripe for union organizers. Given the potential to expand their membership, many non-healthcare unions like the International Brotherhood of Teamsters and United Steelworkers of America have become actively involved in this sector. The health services industry is one of the few sectors in which unions have won >50% of their elections.9


The National Labor Relations Board (NLRB) uses the North American Industry Classification System (NAICS) to track union elections in various sectors of the U.S. economy. One of the union elections conducted by the NLRB recently was in the nursing and personal care facilities (NAICS 623) sector. Given the importance of nursing and personal care facilities and the lack of research in this area, it is vital to examine union election activity in this important healthcare sector. We will first briefly examine the union certification election procedure. Next, we will examine some of the factors that could influence union elections in this sector. We will then discuss the methodology used in this study. This will be followed by the examination and discussion of results.